Pyometra - is filled with purulent contents of the uterine cavity, formed as a result of violations of the physiological process of evacuation of purulent exudate.The accumulation of pus in the uterus occurs after infection with its contents.Most pyometra formed as septic complications in patients on the background of post-natal or post-abortion metroendometrity amid a sharp decrease immunity.Less commonly observed in its appearance decaying infection of cancer of the uterus.
Pyometra not always formed as a result of infectious inflammation.Sometimes the background of pathological occlusion of the cervical canal, or a sharp decline in the tone of the muscular wall of the uterine cavity can be evacuated menstrual blood or bloody exudate after the abortion, dilatation and curettage, or spontaneous preterm delivery (abortion).First, the uterus builds up a large amount of blood that is not able to leave the uterine cavity is formed hemometra.Then, filled with blood, the uterus starts
In the first days after birth can also be formed pyometra, when accumulated in the uterine cavity discharge (called lohiyami) due to uterine atony infected and turn into pus.According to the title of postpartum discharge, uterine cavity with pus referred lohiometroy.
only valid reason for the formation of pyometra education is considered to be obstacles to the free flow of fluid from the uterus.These are can be a blood clot, a polyp or myoma node, the remaining piece of the placenta, and so on.
symptoms of pyometra sometimes meet clinical signs of infection, and can be expressed in a fever, pain, feeling unwell.Only 10% of patients with pyometra observed pus-like leucorrhea with unpleasant putrid odor, and they can also be bloody.Usually, pus or saniopurulent whites appear occasionally when the uterus fails to empty.
If pyometra occurred as a complication metroendometrity, its symptoms can be "masked" the clinical manifestations of acute inflammation in the uterus.
In 50% of patients the presence of pyometra is not accompanied by pronounced Clinic and diagnosis without appropriate examination is difficult to determine.
diagnosis pyometra not take much time.Sometimes (17%), palpation of the uterus fails to detect painful tumor formation in the projection of the uterus.However, more often diagnosed with pyometra is confirmed using a special probe or catheter, it is administered through the cervical canal into the uterine cavity, and then accumulated in the contents of the uterus begins to be evacuated to the outside.
Laboratory diagnosis when pyometra is intended to establish the presence of infection and its character, and an ultrasound scan is necessary to clarify the status of the pelvic organs.
In difficult clinical situations may conduct hysteroscopy, it allows you to explore the uterine cavity and carry out medical manipulations.
Treatment of pyometra, only one - the evacuation of pus from the uterine cavity.After emptying the uterus begin to eliminate infection.Antibiotics for pyometra are appointed according to the bacteriological examination obtained by probing the uterus cables.
If the uterus or cervical canal remains an obstacle to the outflow of uterine contents, pyometra episode could be repeated, so all the pathological formations (polyps, the remains of the ovum, or placenta, etc.) are removed.
reduce the tone of the uterine wall is reduced drugs that increase the contractility of the myometrium (uterotonics).
Pyometra not a harmless condition.The continued presence of large amounts of pus in the uterine cavity threatening severe septic complications and subsequent loss of the uterus.
reason for the formation of pyometra can be considered as any obstacle to normal outflow of the contents of the uterine cavity.It is assumed that initially there is obstruction of the cervical canal, which is due to cervical and uterine secrets are not evacuated, but accumulate.Over time, there is a secondary infection and subsequent transformation of accumulated secretions in purulent contents.
Cervical obstruction provoke:
- Large cervical polyps, distorting the cavity of the cervical canal, creating a mechanical obstacle to the flowing of the uterine cavity serous secretions or menstrual blood.At the same time the uterus is not completely able to periodically emptied, this explains occasional pus after pyometra with putrid odor.
obstruction can trigger cervical polyps and small, have a long "legs" if they "descend" to the outer zevu and closes it.
- Uterine fibroids.If the myoma node is formed near the internal os, with the growth it is able to block partially or completely the cervical canal.
also cross the cervical canal can threaten "born" submucosal (submucous) fibroids.Expanding, they tend to leave the uterus and on the way "clog" it.
- Abnormal narrowing of the cervical canal (stenosis).Cervical stenosis formed in young women as a result of incorrect surgical procedures, as well as after radiotherapy.
Aggressive intervention tool (abortion, diagnostic curettage, hysteroscopy, and the like) can cause the formation of adhesions in a rough area of the cervical canal, which distort and narrow the lumen.
significant number of cases, the diagnosis of pyometra in older women is due to age-stenosis of the cervical canal.
- Foreign body in the uterine cavity: a piece of placenta remaining after childbirth;not removed during the abortion of the fetus;slip into the cervical canal IUD.
However, cases of pyometra without obstruction mechanism found not so rare, so among the reasons for its occurrence are other physiological processes:
- spasms of the cervical canal walls.The leader among the causes of cervical canal stenosis after an abortion.
- Reduction of contractility of the uterine wall (hypotension) or its absence (atony).Occurs against a background of long or obstructed labor and after the birth of the largest fruit."Tired" from excessive uterine contractions are not able to expel the accumulated postpartum blood that accumulates and becomes infected.
- Inflammatory processes in the endometrium.Often the result of improper care (or lack thereof) is endomyometritis pyometra.A large number of inflammatory secretions literally "glues" the wall of the cervical canal, forming a cavity with pus.
sometimes cause pyometra can not be established reliably.Probably, it was eliminated by the body, and pyometra remained as a complication.
Symptoms and signs of pyometra
often pyometra clinical signs are not allowed.Half of the patients it is diagnosed in the survey about a disease or an accident.
pyometra Clinical manifestations are determined by the cause of its occurrence.
Pyometra with acute endometritis or metroendometrity formed in the first few days after abortion or childbirth.Violation of the outflow of blood from the uterus during this period can occur due to violations of the contractility of the uterine wall, stenosis of the cervical canal, clusters of blood clots or having a piece of placental tissue.Skopje uterus blood is breeding ground for pathogenic microorganisms that make the uterus filled with pus closed cavity.Most of the existing symptoms associated with acute infectious process: high fever, intense pain, feeling unwell, can pus-like discharge with an unpleasant odor.The only reliable sign indicating pyometra, is a sudden decrease or complete cessation of discharge after abortion or childbirth, especially during the first three days.
Sometimes pyometra is the result of accumulation of menstrual blood in the uterus (hematometra) as a result of mechanical or functional obstruction.Menstruation ceases or becomes very scarce and out of season, there are nagging pains.If blood flow is not restored in the short term, develop local infectious inflammation and pus fills the uterine cavity.
suspect the presence of pyometra is possible after a careful survey of the patient.At gynecological examination, if projection of the uterus palpable painful education testovatoy consistency against the backdrop of a clear obstruction of the cervical canal is made of medical-diagnostic probe or catheter uterine cavity.When gently injected into the cervical canal probe reaches the uterine cavity, its contents (blood and / or pus) flows out.The resulting exudate is sent to a lab for testing to determine the nature of the infection and to determine the most effective way to destroy it.
selected after pyometra in probing may be purulent as long as adequate antibiotic therapy is not started, but after treatment, they should relate to the norm.
Ultrasound examination reveals the presence of fibroids, polyps or inflammation.The most accurate information about the uterine cavity, and all the processes occurring in it provides a hysteroscopy.
Treatment of pyometra
Confirmed pyometra is subject to compulsory treatment in a gynecological hospital.Initially, the uterus is released from pus and blood.
On further treatment tactics affect the cause of formation of pyometra.When she appeared on the background of the delay parts of the fetus after abortion or pieces of placental tissue after birth, produce curettage, followed by washing the vacant cavity with antiseptic solutions.
Antibiotic therapy is the leading method of pyometra.Antibiotics for pyometra are selected according to the results of bacteriological research, but they should be "connected" immediately after the patient's admission to hospital and waiting for a response from the bacteriological laboratory takes time.Therefore initially selected antibiotics (usually two types) capable to destroy as many pathogenic microorganisms, and when the test results are ready, they are either continued or replaced.
conjunction with antibiotic therapy uses drugs relieve pain, restore proper muscle tone walls, vitamins and immune stimulants.
surgically removed cervical polyps, which create obstacles to the normal evacuation of uterine contents.It should be noted that any cervical polyp, even if it does not "interfere" in the term (besides other complications) can significantly grow and block the cervical canal.Therefore, subject to the removal of all detected cervical polyps.
serious clinical situation is a combination of fibroids and pyometra.As a rule, most collection of pus in the uterus myoma provokes festering node or fibroids with subserous location.We have not implemented the reproductive function of young patients, it is desirable to conduct gentle preserving the uterus, surgical procedures when only removes fibroids.However, in case of extensive suppurative inflammation when uterine tissue literally melt and almost impossible to keep the body.